Legislation to Bring Transparency to MA Introduced

Representative Katie Porter (D-CA) introduced legislation this week that would require Medicare Advantage (MA) plans to provide data on supplemental benefits, patient encounters, and prior authorization. This legislation is a step in the right direction to ensure lawmakers have the right information on MA as a path forward to addressing overpayments and stabilizing the finances of the Medicare trust fund. 

The legislation, the Medicare Advantage Consumer Protection and Transparency Act (H.R. 9019) would require MA plan transparency for supplemental benefit usage data, such as hearing, vision, dental, meals, transportation, and other benefits not covered under traditional health insurance or Medicare. Specifically, the bill would require data to be submitted by MA plans to the Department of Health and Human Services that includes each type of supplemental benefit offered, the number of eligible enrollees, total plan expenditures, and other information. The bill would also require transparency of encounter data and prior authorization information. 

Requiring MA plans to report supplemental benefit information would provide lawmakers with the necessary information to prove that excessive payments to MA plans are only in part going to more benefits for seniors, with funds adding to plan profits. 

According to Representative Porter:

Insurers that provide older adults with subpar care should be held accountable—and we need to have the data to do it. The current system we have allows Medicare Advantage plans to escape scrutiny, depriving older Americans of the care they need and cheating taxpayers out of what we all pay for. Our Medicare Advantage Consumer Protection and Transparency Act will empower watchdogs and lawmakers to verify that Medicare Advantage is working as well as it should be.

As the Senate considers House-passed legislation that would increase MA costs by $16 billion, they might consider adding new transparency requirements like these to the program. They should also, of course, fully offset any new spending. 

Maya MacGuineas, president of the Committee for a Responsible Federal Budget, said of the bill:

We applaud Congresswoman Porter for putting forward legislation to bring transparency to Medicare Advantage. With the Medicare trust fund just a few years from insolvency, this is an important step towards addressing Medicare Advantage overpayments. Almost half of all Medicare beneficiaries are enrolled in Medicare Advantage plans and it is essential that lawmakers know how taxpayer dollars are being spent by these private plans.

Learn more about the status of Medicare Advantage and federal costs by checking out our in-depth analyses:

• New MA Bill Would Increase Medicare Costs
• Committee Sends Letter to CMS on Medicare Advantage
• Analysis of the 2022 Medicare Trustees' Report 
• Medicare Advantage Costs Continue to Rise
• Can Medicare Advantage Reforms Save the Trust Fund?
• Reducing Medicare Advantage Overpayments